Moreira-Pinto João, Ferreira Aníbal, Miranda Alice, Rolanda Carla, Correia-Pinto Jorge
Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Campus de Gualtar, 4709-057, Braga, Portugal,
Surg Endosc. 2014 Sep;28(9):2671-8. doi: 10.1007/s00464-014-3525-7. Epub 2014 Apr 25.
Video-assisted thoracoscopic surgery thymectomy has been used in the treatment of Myastenia Gravis and thymomas (coexisting or not). In natural orifice transluminal endoscopic surgery, new approaches to the thorax are emerging as alternatives to the classic transthoracic endoscopic surgery. The aim of this study was to assess the feasibility and reliability of hybrid endoscopic thymectomy (HET) using a combined transthoracic and transesophageal approach.
Twelve consecutive in vivo experiments were undertaken in the porcine model (4 acute and 8 survival). The same procedure was assessed in a human cadaver afterward. For HET, an 11-mm trocar was inserted in the 2nd intercostal space in the left anterior axillary line. A 0° 10-mm thoracoscope with a 5-mm working channel was introduced. Transesophageal access was created through a submucosal tunnel using a flexible gastroscope with a single working channel introduced through the mouth. Using both flexible (gastroscope) and rigid (thoracoscope) instruments, the mediastinum was opened; the thymus was dissected, and the vessels were ligated using electrocautery alone.
Submucosal tunnel creation and esophagotomy were performed safely without incidents in all animals. Complete thymectomy was achieved in all experiments. All animals in the survival group lived for 14 days. Thoracoscopic and postmortem examination revealed pleural adhesions on site of the surgical procedure with no signs of infection. Histological analysis of the proximal third of the esophagus revealed complete cicatrization of both mucosal defect and myotomy site. In the human cadaver, we were able to replicate all the procedure even though we were not able to identify the thymus.
Hybrid endoscopic thymectomy is feasible and reliable. HET could be regarded as a possible alternative to classic thoracoscopic approach for patients requiring thymectomy.
电视辅助胸腔镜胸腺切除术已用于治疗重症肌无力和胸腺瘤（无论是否并存）。在经自然腔道内镜手术中，新的胸部手术入路正在出现，可作为传统经胸内镜手术的替代方法。本研究的目的是评估采用经胸和经食管联合入路的杂交内镜胸腺切除术（HET）的可行性和可靠性。
在猪模型上进行了12次连续的体内实验（4次急性实验和8次存活实验）。随后在一具人类尸体上评估了相同的手术过程。对于HET，在左腋前线第2肋间插入一个11毫米的套管针。引入一个带有5毫米工作通道的0°10毫米胸腔镜。通过使用经口腔插入的单通道柔性胃镜，经黏膜下隧道建立经食管入路。使用柔性（胃镜）和刚性（胸腔镜）器械打开纵隔；解剖胸腺，仅用电灼法结扎血管。
所有动物均安全完成黏膜下隧道建立和食管切开术，无并发症发生。所有实验均成功完成胸腺切除术。存活组的所有动物均存活14天。胸腔镜检查和尸检显示手术部位有胸膜粘连，但无感染迹象。食管近端三分之一的组织学分析显示黏膜缺损和肌切开部位均完全瘢痕化。在人类尸体上，尽管我们未能识别出胸腺，但仍能够重复所有手术步骤。
杂交内镜胸腺切除术是可行且可靠的。对于需要进行胸腺切除术的患者，HET可被视为传统胸腔镜手术方法的一种可能替代方案。
